BILL ANALYSIS                                                                                                                                                                                                    



                                                                     SB 914


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          Date of Hearing:  June 22, 2016


                           ASSEMBLY COMMITTEE ON INSURANCE


                                   Tom Daly, Chair


          SB  
          914 (Mendoza) - As Introduced January 26, 2016


          SENATE VOTE:  36-0


          SUBJECT:  Workers' compensation:  medical provider networks:   
          independent medical reviews


          SUMMARY:  Repeals outdated references to certain medical  
          treatment guidelines.  Specifically, this bill deletes several  
          references to the American College of Occupational and  
          Environmental Medicine's (ACOEM) treatment guidelines from the  
          Labor Code.


          EXISTING LAW:   


          1)Establishes a comprehensive system to provide benefits,  
            including medical treatment, to employees who are injured or  
            suffer conditions that arise out of or in the course of  
            employment.


          2)Requires treatment to be evidence-based, as detailed in a  
            Medical Treatment Utilization Schedule adopted and maintained  
            by the Administrative Director (AD) of the Division of  








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            Workers' Compensation (DWC).


          3)Required, subsequent to the 2004 workers' compensation  
            reforms, that the ACOEM guidelines be utilized when making  
            medical treatment decisions, until such time as the AD adopted  
            alternative guidelines.  


          4)Continues to reference ACOEM despite the AD having adopted  
            alternative guidelines.


          FISCAL EFFECT:  Undetermined; the bill is keyed non-fiscal by  
          Legislative Counsel.


          COMMENTS:  


          1)Purpose.  According to the author, the DWC has suggested that  
            the Labor Code be cleaned up to reflect the fact that the  
            references to ACOEM are no longer accurate, and could  
            potentially be confusing.  The bill is the author's effort to  
            accomplish this goal.


          2)Background.  In 2004, the Legislature passed SB 899  
            (Poochigian), Chapter 34, Statutes of 2004, which was a major  
            reform of the California workers' compensation system. As a  
            part of that reform, SB 899 required the DWC to create an  
            evidence-based set of medical guidelines to ensure that  
            injured workers were receiving consistent, appropriate  
            treatment from physicians. In the intervening period, SB 899  
            required that physicians use the ACOEM guidelines, which are a  
            set of widely-utilized evidence-based, peer reviewed medical  
            guidelines that continue to be used in California's workers'  
            compensation system and many other state workers' compensation  
            systems.








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            In 2009, the DWC promulgated the California-specific workers'  
            compensation system medical treatment guidelines known as the  
            MTUS.  The MTUS utilized many of the chapters that make up  
            ACOEM, but also referenced additional guidelines or developed  
            independent guidance on medical treatment. As such, while  
            ACOEM is still used as a part of the MTUS, it no longer  
            operates as a stand-alone guideline, and the references to it  
            in the Labor Code can be confusing and cause practitioners to  
            fail to refer to the MTUS.


          REGISTERED SUPPORT / OPPOSITION:




          Support


          None received




          Opposition


          None received




          Analysis Prepared by:Mark Rakich / INS. / (916)  
          319-2086











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